The 21st Conference on Retroviruses and Opportunistic Infections (CROI 2014) kicked off in Boston this week with a program for young investigators, a press conference on new hepatitis C treatments, and opening lectures on HIV immune response and cross-species transmission and an update on the epidemic in West Africa.

HIVandHepatitis.com will be on site all week bringing you the latest news.

This year's conference -- the major U.S. annual scientific meeting on HIV/AIDS -- is being run for the first time by the new CROI Foundation, under the auspices of the International Antiviral Society-USA (IAS-USA). Speaking to the media on Monday, CROI Chair Kevin DeCock said that the conference has drawn more than 4400 registrants and about 1000 abstracts will be presented in oral and poster sessions.

CROI Vice Chair Julie Overbaugh gave an overview of basic science to be presented at the meeting. "Interferon is on the way out for HCV, but appears to be on the way in for HIV," she said. Interferon's role in HIV was discussed in an opening lecture by Paul Bieniasz from the Aaron Diamond AIDS Research Center and will be the topic of a morning plenary, oral abstracts, and a symposium later in the week.

Judith Currier from the University of California at Los Angeles reviewed some of the HIV clinical studies to be presented at CROI 2014. "At this stage of the epidemic, we're focused on getting treatment to people who need it," she said. The benefits of early antiretroviral therapy (ART) will be a theme throughout the conference. While there is "not as much on new drugs" for HIV, she noted, long-acting antiretrovirals are being tested both for treatment and for prevention.

Other topics will include the use of ART to prevent mother-to-child HIV transmission, ART for children, and pre-exposure prophylaxis, as well as new information on related conditions such as tuberculosis, human papillomavirus (HPV), malignancies, and cardiovascular and pulmonary complications in people with HIV.

Hepatitis C Advances and Challenges

Hepatitis C and HIV/HCV coinfection will also be a key theme of this year's CROI, at a time when next-generation direct-acting antivirals are entering widespread clinical use in the U.S. and the first interferon-free regimens are becoming available.

Discussing studies of the direct-acting agents sofosbuvir (Sovaldi), faldaprevir, and simeprevir, Douglas Dieterich from Mt. Sinai said that cure rates using the new drugs are the same for HIV/HCV coinfected people as for those with HCV alone -- in contrast to interferon, which does not work as well in people with HIV. In fact, he added, several traditional predictors of response -- including black race and extent of liver fibrosis -- "all the old predictors of response are gone when you have a potent 2-3 drug combination."

While Dieterich noted that the newly approved sofosbuvir is "flying off the shelves" at a rate of about 2000 prescriptions per week, there are still barriers to successful hepatitis C treatment in the real world, according to speakers at the press conference and a panel of activists at this year's Martin Delaney lecture, named after the prominent AIDS treatment activist and Project Inform founder.

These barriers include inadequate screening and diagnosis, prejudice against treating people who inject drugs, shortage of knowledgeable providers, and the high cost of new drugs that will impact people with HCV in high, middle, and low-income countries.

Hepatitis C treatment is currently a "dribble" rather than a cascade, said Tracy Swan of the Treatment Action Group. While hepatitis C has the benefit of a cure, it is lacking the political will, global collaborations, research networks, infrastructure, funding, and community identity that have turned around the HIV epidemic. "One thing HIV has taught us that the community response is absolutely essential to transforming an epidemic," she emphasized.

"I am concerned that interferon-free regimens will not magically advance treatment access," added Lynn Taylor from Brown University. "[Hepatitis C] affects the most disenfranchised [people]. It cannot be evaluated in a profit-and-loss chart, or we're always going to lose."

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